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Predictive Value of Resting Pd/Pa for Fractional Flow Reserve Assessed with Monorail Pressure Microcatheter in Real-World Practice

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Cardiovascular Innovations and Applications 2019年第B7期4卷 113-120页

作者： Keng Tat Koh Asri Said Khaw Chee Sin Oon Yen Yee Erwin Mulia Tan Chen Ting Francis Shu Eng Pbeng Ho Kian Hui Voon Chi Yen Cham Yee Ling Khiew Ning Zan Nor Hanim Mohd Amin Alan Fong Yean Yip ong tiong kiam Department of Cardiology Sarawak Heart Centre3rd RoundaboutSamarahan Expressway94300 Kota SamarahanSarawakMalaysia Faculty of Medicine and Health Sciences University Malaysia Sarawak94300 Kota SamarahanSarawakMalaysia Clinical Research Centre Sarawak General HospitalJalan Hospital 93586 KuchingSarawakMalaysia

Background and Objectives:The aims of this study were(1)to examine the diagnostic accuracy of resting timeaveraged distal coronary pressure(Pd)to mean aortic pressure(Pa)ratio to predict hyperemic fractional flow reserve(FFR)and(2)to identify a resting Pd/Pa value that can preclude the need for hyperemic FFR assessed with use of a monorail pressure ***:A total of 191 stenoses were *** exclusions,157 FFR data sets from 103 patients were ***:Resting Pd/Pa showed poor agreement with hyperemic FFR(r=0.619,P<0.001).The receiver operating characteristic curve for resting Pd/Pa with reference to hyperemic FFR of 0.80 or less showed an area under the curve of 0.800(95%confi dence interval 0.732– 0.868,P<0.001),with the greatest diagnostic accuracy of 74.5%for resting Pd/Pa of less than *** Pd/Pa of 0.96 or greater had a sensitivity of 100%and a negative predictive value of 100%,and resting Pd/Pa of 0.82 or less had a specifi city of 98.9%and a positive predictive value of 94.1%to predict abnormal FFR of 0.80 or *** results were consistent regardless of the vessels studied,the location of lesions,and the severity of ***:Resting Pd/Pa showed poor agreement with hyperemic FFR assessed with use of a monorail pressure ***,resting Pd/Pa of 0.96 or greater had excellent sensitivity and negative predictive value to predict normal hyperemic FFR,and resting Pd/Pa of 0.82 or less had excellent specifi city and positive predictive value to predict abnormal hyperemic FFR.

关键词： fractional fl ow reserve monorail pressure catheter resting time-averaged distal coronary pressure to mean aortic pressure ratio

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The coronary computed tomography angiogram: from the basics to advanced interpretation

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Journal of Geriatric Cardiology 2006年第1期3卷 35-44页

作者： tiong kiam ong Stephan Achenbach Department of Cardiology Jalan Tun Ahmad Zaidi Adruce Kuching Sarawak 93586 Malaysia Department of Internal Medicine Ⅱ (Cardiology) University of Erlangen Nuremberg Germang

　　Introduction　　According to the WHO's World Health Report 2003, 1cardiovascular disease was responsible for 16.7 million deaths annually. As a result, it is now the leading cause of death in developed countries and in many developing countries. Detecting and preventing the progression of coronary artery disease is the target of many pharmaceutical, technological and other scientific programs today. Presently, the main diagnostic tool for evaluating coronary arteries is thc conventional coronary angiogram (CCA).……

关键词： MPR from the basics to advanced interpretation The coronary computed tomography angiogram CTA MDCT oral MIP

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64-row multi-dector computed tomography coronary image from a center with early experience: first illustration of learning curve

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Journal of Geriatric Cardiology 2006年第1期3卷 29-34页

作者： Sze Piaw CHIN tiong kiam ong Chee Khoon LIEW M.Tobias Seyfarth Fong Yean Yip ALAN Houng Bang LIEW Kui Hian SIM Dept of Cardiology Sarawak General Hospital Siemens Cardiac Solutions Erlangen Germany

Background and objectives The recent joint ACCF/AHA clinical competence statement on cardiac imaging with multi-detector computed tomography recommended a minimum of 6 months training and 300 contrast examinations, of which the candidate must be directly involved in at least 100 studies. Whether this is adequate to become proficient in interpretation of coronary computed tomogsignificant coronary stenosis in a center with 1 year's experience using a 64-row scanner. Methods A total of 778 patients underwent contrast-enhanced CTA between January and December 2005. Out of these patients, 301 patients also underwent contrast-enhanced conventional coronary angiography (CCA). These patients were divided into 4 groups according to the time the examination was underwent. Group Q1: first quarter of the year (n=20), Group Q2: second quarter (n=128), Group Q3: third quarter (n=134), and Group Results The sensitivity, specificity, positive, and negative predictive values were Q1 - 64%, 89%, 49% and 94%, respectively; Q2 -79%, 96%, 74% and 97%, respectively; Q3 - 78%, 96%, 74%, 97%, respectively, and Q4 - 100% for all. Conclusions In a center with formal training and high caseload, our accuracy in CTA analysis reached a plateau after 6 months experience. Test-bolus protocols produce better image quality and can improve accuracy. New centers embarking on CTA will need to overcome an initial 6-month learning curve depending upon the caseload during which time they should consider correlation with CCA.

关键词： computed tomography training angiography coronary artery disease

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Assessment of left ventricular ejection fraction: comparison of two dimensional echocardiography, cardiac magnetic resonance imaging and 64-row multi-detector computed tomography

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Journal of Geriatric Cardiology 2006年第1期3卷 2-8页

作者： Chee Khoon LIEW Rapaee ANNUAR tiong kiam ong Sze Piaw CHIN Tobias Seyfarth Yean Yip Fong Choon Kiat ANG Houng Bang LIEW Kui Hian SIM Department of Cardiology Sarawak General Hospital Sarawak Malaysia University Malaysia Sarawak Siemens Cardiac Solutions Erlangen Germany Department of Cardiology Sarawak General Hospital SarawakMalaysia

Objectives To compare left ventricular ejection fraction (LVEF) determined from 64-row multi-detector computed tomography (64-row MDCT) with those determined from two dimensional echocardiography (2D echo) and cardiac magnetic resonance imaging (CMR). Methods Thirty-two patients with coronary artery disease underwent trans-thoracic 2D echo, CMR and contrast-enhanced 64-row MDCT for assessment of LVEF within 48 hours of each other. 64-row MDCT LVEF was derived using the Syngo Circulation software; CMR LVEF was by Area Length Ejection Fraction (ALEF) and Simpson method and 2D echo LVEF by Simpson *** The LVEF was 49.13 ± 15.91% by 2D echo, 50.72 ± 16.55% (ALEF method) and 47.65 ± 16.58%(Simpson method) by CMR and 50.00 ± 15.93% by 64-row MDCT. LVEF measurements by 64-row MDCT correlated well with LVEF measured with CMR using either the ALEF method (Pearson correlation r = 0.94, P ＜0.01) or Simpson method (r = 0.92, P＜0.01). It also correlated well with LVEF measured using 2D echo (r = 0.80, P ＜ 0.01). Conclusion LVEF measurements by 64-row MDCT correlated well with LVEF measured by CMR and 2D echo. The correlation between 64-row MDCT and CMR was better than the correlation between 2D echo with CMR. Standard data set from a 64-row MDCT coronary study can be reliably used to calculate the LVEF.

关键词： ejection fraction echocardiography magnetic resonance imaging computed tomography

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Feasibility and accuracy of coronary imaging in elderly patients using the 64-row multi-detector computed tomography: a correlation study with conventional coronary angiography

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Journal of Geriatric Cardiology 2006年第1期3卷 9-14页

作者： Chee Khoon LIEW Sze Piaw CHIN tiong kiam ong Seyfarth Tobias Yean Yip Fong Choon Kiat ANG Houng Bang LIEW Rapaee ANNUAR Kui Hian SIM Deptartment of Cardiology Sarawak General Hospital SarawakMalaysia Siemens Cardiac Solutions Erlangen Germany Universitv Malaysia Sarawak Malaysia

Background Elderly patients generally have higher occurrence of coronary calcification, increased heart rate and difficulty with prolonged breath-holding. The aim of our study was to investigate the feasibility and accuracy of using 64-row multi-detector computed tomography (MDCT) in the assessment of coronary artery stenoses in elderly patients. Methods One hundred and fifty two patients with suspected or known coronary artery disease were divided into 4 groups according to their age (Group A: 40-49 years,n=34; Group B: 50-59 years, n=57; Group C: 60-69 years, n=48; Group D: 70 years and above; n=13). Coronary CT angiography (CTA) using a 64-row MDCT was performed and the findings were compared with that of conventional coronary angiography (CCA).Using axial images, multi-planar reconstructions (MPR) and maximum intensity projections (MIP), coronary segments of lumen diameter = 1.5mm were analyzed for the presence of significant stenosis (= 50% ). Results Percentages of poor image quality from coronary CTA preventing reliable correlations with CCA were 21%, 14%, 19% and 62% in Groups A to D respectively. Patients in Group D had significantly higher calcium scores compared with the other groups (P＜0.001). In patients where CTA images were of acceptable quality, percentages of accurate correlations with CCA were 89.8%, 93.4%, 86.6% and 78.0% for Groups A to D *** were no significant difference in serum creatinine, heart rate and contrast volume between the 4 groups. Conclusions The 64-row MDCT coronary angiography was less accurate and feasible for patients aged 70 years or above due to heavy coronary calcification and inability to perform a satisfactory breath-hold. However, a high diagnostic accuracy with the MDCT is possible in patients aged less than 70 years.

关键词： computed tomography angiography coronary artery disease elderly

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High-resolution computed tomography in patients with atypical 'cardiac' chest pain: a study investigating patients at 10-year cardiovascular risks defined by the Framingham and PROCAM scores

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Journal of Geriatric Cardiology 2006年第1期3卷 17-21页

作者： Choon Kiat ANG Alan Yean Yip Fong Sze Piaw CHIN tiong kiam ong Seyfarth M Tobias Chee Khoon LIEW Rapaee ANNUAR Houng Bang LIEW Kui Hian SIM Deptartment of Cardiology Sarawak General Hospital Sarawak Malaysia Siemens Medical Solutions Germany Deptartment of Cardiology Sarawak General Hospital SarawakMalaysia University Malaysia Sarawak Malaysia

Background and objective Atypical 'cardiac' chest pain (ACCP) is not usually caused by myocardial ischaemia. Current noninvasive investigations for these symptoms are not yet as accurate as invasive coronary angiography. The latest 64-row multi-detector computed tomography (MDCT) technology is non-invasive, has high specificity and negative predictive values for the detection of significant coronary disease. Our aim was to investigate if this modality can provide more information in the assessment of outpatients with ACCP in addition to established cardiovascular risk scores. Methods Seventy consecutive patients presenting to the outpatient clinic with ACCP underwent 64-row MDCT scan of the coronary arteries. They were categorized into low, medium or high risk groups based upon the Framingham and PROCAM scores. We defined a clinically abnormal MDCT scan as coronary stenosis =50% or calcium score ＞400 Agatston. Results Fifty-three (75.7%) patients did not have clinically abnormal scans. Framingham score classified 43 patients as low-risk while PROCAM classified 59 patients as low-risk. MDCT scans were abnormal for 18.6% and 22.0% of the respective low-risk group of patients. For patients with medium-to-high risk, 33.3% and 36.4% of Framingham and PROCAM patient groups respectively had abnormal MDCT scans. Conclusion MDCT adds valuable information in the assessment of patients with ACCP by identifying a significant proportion of patients categorized as low-risk to have underlying significant coronary stenosis and coronary calcification by established cardiovascular risk scores.

关键词： multi-detector computed tomography atypical 'cardiac' chest pain coronary artery disease risk stratification

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